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Management of patients with extended pancreatic necrosis
R Isenmann1, B Rau, U Zoellner
1Department of General Surgery, University of Ulm, Steinhoevelstrasse 9, D-89075 Ulm, Germany.
Background:
Extended pancreatic necrosis pose a considerable therapeutic problem in patients with necrotizing pancreatitis.
Aim:
Factors that limit conservative treatment in patients with extended pancreatic necrosis were analyzed.
Methods:
The clinical course of 61 patients with an extent of necrosis of more than 50% of the gland (according to contrast-enhanced CT scan) were analysed with special regard to systemic complications. Indications for surgical treatment were either persistent organ failure or pancreatic infection.
Results:
10 patients were managed by conservative treatment, 51 (84%) patients underwent operation. Indications for surgery were sepsis with or without organ failure in 17 patients, persistent organ failure in another 17 patients, persistent SIRS in 13 patients and local complications in 4 patients. Pancreatic infection was present in 25 patients. The incidence of systemic complications did not differ between infected and sterile necrosis, but they occurred earlier in sterile necrosis.
Conclusions:
Persistent organ failure is limiting conservative treatment during the early course in patients with sterile necrosis. The latter course is characterized by a high incidence of pancreatic infection and septic organ failure.